Quality Assurance

Transition of Care Issues

You may be able to get a temporary supply

Under certain circumstances, the plan can offer a temporary supply of a drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your doctor about the change in coverage and figure out what to do.

To be eligible for a temporary supply, you must meet the two requirements below:

The change to your drug coverage must be one of the following types of changes:
- The drug you have been taking is no longer on the plan's Drug List
- The drug you have been taking is now restricted in some way
You must be in one of the situations described below:

For those members who were in the plan last year and are not in a long-term care facility:

We will cover a temporary supply of your drug one time only during the first 90 days of the calendar year. This temporary supply will be for a maximum of a 30-day supply, or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.

For those members who are new to the plan and are not in a long-term care facility:

We will cover a temporary supply of your drug one time only during the first 90 days of your membership in the plan. This temporary supply will be for a maximum of a 30-day, or less if your prescription is written for fewer days. The prescription must be filled at a network pharmacy.

For those who have been a member of the plan for more than 90 days, and are a resident of a long-term care facility and need a supply right away:

We will cover one 31-day supply, or less if your prescription is written for fewer days. This is in addition to the above long-term care transition supply.

Our plan will cover a temporary 31-day supply of non-formulary drugs (unless the prescription is written for fewer days) for current members with level of care changes.

To ask for a temporary supply, call Member Services Toll-Free at (866) 704-0109.

During the time when you are getting a temporary supply of a drug, you should talk with your doctor to decide what to do when your temporary supply runs out. Perhaps there is a different drug covered by the plan that might work just as well for you. Or you and your doctor can ask the plan to make an exception for you and cover the drug in the way you would like it to be covered. The sections below tell you more about these options.

If you need medical attention or need to fill prescriptions after your coverage begins, but have not received your ID card, please have your medical provider or pharmacist call Vantage at 1-318-361-0900, Toll-Free 1-888-823-1910 or TTY at 1-866-524-5144 (for the hearing impaired).

Medication Therapy Management Programs

Programs To Help Members Use Drugs Safely

Vantage Health Plan conducts drug use reviews for our members to help make sure they are getting safe and appropriate care. These reviews are especially important for members who have more than one provider who prescribes their drugs.

We do a review each time you fill a prescription. We also review our records on a regular basis. During these reviews we look for potential problems such as:

Possible medication errors.
Drugs that may not be necessary because you are taking another drug to treat the same medical condition.
Drugs that may not be safe or appropriate because of your age or gender.
Certain combinations of drugs that could harm you if taken at the same time.
Prescriptions written for drugs that have ingredients you are allergic to.
Possible errors in the amount (dosage) of a drug you are taking.

If we see a possible problem in your use of medications, we will work with your doctor to correct the problem.

Programs To Help Members Manage Their Medications

Vantage Health Plan has programs that can help our members with special situations. For example, some members have several complex medical conditions, they may need to take many drugs at the same time, or they could have very high drug costs.

These programs are voluntary and free to members and are not considered a benefit. A team of pharmacists and doctors developed the program for us. The programs can help make sure that our members are using the drugs that work best to treat their medical conditions and help us identify possible medication errors.

If we have a program that fits your needs, we will automatically enroll you in the program and send you information. If you decide not to participate, please notify us and we will withdraw your participation in the program.

If you would like additional information about the Medication Therapy Management (MTM) Program, please call Vantage Health Plan, toll free (888) 823-1910. TTY users please call (866) 524-5144.

This page was last updated:7/10/2019